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Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism
SUMMARY: Standard treatment of hypoparathyroidism consists of supplementation of calcium and vitamin D analogues, which does not fully restore calcium homeostasis. In some patients, hypoparathyroidism is refractory to standard treatment with persistent low serum calcium levels and associated clinica...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Bioscientifica Ltd
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274549/ https://www.ncbi.nlm.nih.gov/pubmed/32478671 http://dx.doi.org/10.1530/EDM-20-0009 |
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author | Fuss, Carmina Teresa Burger-Stritt, Stephanie Horn, Silke Koschker, Ann-Cathrin Frey, Kathrin Meyer, Almuth Hahner, Stefanie |
author_facet | Fuss, Carmina Teresa Burger-Stritt, Stephanie Horn, Silke Koschker, Ann-Cathrin Frey, Kathrin Meyer, Almuth Hahner, Stefanie |
author_sort | Fuss, Carmina Teresa |
collection | PubMed |
description | SUMMARY: Standard treatment of hypoparathyroidism consists of supplementation of calcium and vitamin D analogues, which does not fully restore calcium homeostasis. In some patients, hypoparathyroidism is refractory to standard treatment with persistent low serum calcium levels and associated clinical complications. Here, we report on three patients (58-year-old male, 52-year-old female, and 48-year-old female) suffering from severe treatment-refractory postsurgical hypoparathyroidism. Two patients had persistent hypocalcemia despite oral treatment with up to 4 µg calcitriol and up to 4 g calcium per day necessitating additional i.v. administration of calcium gluconate 2–3 times per week, whereas the third patient presented with high frequencies of hypocalcemic and treatment-associated hypercalcemic episodes. S.c. administration of rhPTH (1–34) twice daily (40 µg/day) or rhPTH (1–84) (100 µg/day) only temporarily increased serum calcium levels but did not lead to long-term stabilization. In all three cases, treatment with rhPTH (1–34) as continuous s.c. infusion via insulin pump was initiated. Normalization of serum calcium and serum phosphate levels was observed within 1 week at daily 1–34 parathyroid hormone doses of 15 µg to 29.4 µg. Oral vitamin D and calcium treatment could be stopped or reduced and regular i.v. calcium administration was no more necessary. Ongoing efficacy of this treatment has been documented for up to 7 years so far. Therefore, we conclude that hypoparathyroidism that is refractory to both conventional treatment and s.c. parathyroid hormone (single or twice daily) may be successfully treated with continuous parathyroid hormone administration via insulin pump. LEARNING POINTS: Standard treatment of hypoparathyroidism still consists of administration of calcium and active vitamin D. Very few patients with hypoparathyroidism also do not respond sufficiently to standard treatment or administration of s.c. parathyroid hormone once or twice daily. In those cases, continuous s.c. administration of parathyroid hormone via insulin pump may represent a successful treatment alternative. |
format | Online Article Text |
id | pubmed-7274549 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | Bioscientifica Ltd |
record_format | MEDLINE/PubMed |
spelling | pubmed-72745492020-06-10 Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism Fuss, Carmina Teresa Burger-Stritt, Stephanie Horn, Silke Koschker, Ann-Cathrin Frey, Kathrin Meyer, Almuth Hahner, Stefanie Endocrinol Diabetes Metab Case Rep Novel Treatment SUMMARY: Standard treatment of hypoparathyroidism consists of supplementation of calcium and vitamin D analogues, which does not fully restore calcium homeostasis. In some patients, hypoparathyroidism is refractory to standard treatment with persistent low serum calcium levels and associated clinical complications. Here, we report on three patients (58-year-old male, 52-year-old female, and 48-year-old female) suffering from severe treatment-refractory postsurgical hypoparathyroidism. Two patients had persistent hypocalcemia despite oral treatment with up to 4 µg calcitriol and up to 4 g calcium per day necessitating additional i.v. administration of calcium gluconate 2–3 times per week, whereas the third patient presented with high frequencies of hypocalcemic and treatment-associated hypercalcemic episodes. S.c. administration of rhPTH (1–34) twice daily (40 µg/day) or rhPTH (1–84) (100 µg/day) only temporarily increased serum calcium levels but did not lead to long-term stabilization. In all three cases, treatment with rhPTH (1–34) as continuous s.c. infusion via insulin pump was initiated. Normalization of serum calcium and serum phosphate levels was observed within 1 week at daily 1–34 parathyroid hormone doses of 15 µg to 29.4 µg. Oral vitamin D and calcium treatment could be stopped or reduced and regular i.v. calcium administration was no more necessary. Ongoing efficacy of this treatment has been documented for up to 7 years so far. Therefore, we conclude that hypoparathyroidism that is refractory to both conventional treatment and s.c. parathyroid hormone (single or twice daily) may be successfully treated with continuous parathyroid hormone administration via insulin pump. LEARNING POINTS: Standard treatment of hypoparathyroidism still consists of administration of calcium and active vitamin D. Very few patients with hypoparathyroidism also do not respond sufficiently to standard treatment or administration of s.c. parathyroid hormone once or twice daily. In those cases, continuous s.c. administration of parathyroid hormone via insulin pump may represent a successful treatment alternative. Bioscientifica Ltd 2020-05-29 /pmc/articles/PMC7274549/ /pubmed/32478671 http://dx.doi.org/10.1530/EDM-20-0009 Text en © 2020 The authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. (http://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Novel Treatment Fuss, Carmina Teresa Burger-Stritt, Stephanie Horn, Silke Koschker, Ann-Cathrin Frey, Kathrin Meyer, Almuth Hahner, Stefanie Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism |
title | Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism |
title_full | Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism |
title_fullStr | Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism |
title_full_unstemmed | Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism |
title_short | Continuous rhPTH (1–34) treatment in chronic hypoparathyroidism |
title_sort | continuous rhpth (1–34) treatment in chronic hypoparathyroidism |
topic | Novel Treatment |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274549/ https://www.ncbi.nlm.nih.gov/pubmed/32478671 http://dx.doi.org/10.1530/EDM-20-0009 |
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